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Social Security Disability for Degenerative Disc Disease

If you suffer from degenerative disc disease and it renders you unable to work, you may be eligible to receive Social Security Disability benefits. Social Security Disability Insurance (SSDI) is a program offered through the Social Security Administration (SSA) for working individuals who become disabled because of injuries or illness.

In order to be eligible for Social Security Disability, your disc disease has had to progress into a severe form that has impacted the vertebrae so it causes chronic pain and impacts your ability to stand or sit for significant periods of time, which can be made evident through medical imaging.

Also, you have had to work enough to earn sufficient credits to qualify for SSDI. This means you have had to pay enough taxes in to the SSA programs during the specified time period as well. Degenerative disc disease could be one of the most common impairments for which people seek benefits, but it is not easy to get benefits especially for younger people.

However, it is not impossible to win benefits for degenerative disc disorder if you can prove your disability and have everything documented. As soon as you have been diagnosed with degenerative disc disorder you should start documenting everything and make sure your physicians do the same.

The SSDI claims process involves extensive medical records, including documents pertaining to tests and procedures, as well as evidence of how your daily life has been impacted by the disorder. It is your job to prove that the condition has left you unable to work.

The Cost of Treating Degenerative Disc Disorder

According to Cost Helper, the treatment of degenerative disc disorder can be expensive. Symptoms can include pain, tingling sensations, numbness in the back and weakness in leg muscles. If you have health insurance, you can expect doctor visit copays plus prescription copays or coinsurance costs ranging from 10% to 50%. While many treatments for the problem are covered by health insurance, there are treatment options that may not be covered by all plans.

Those who do not have health insurance coverage can expect to pay about $200 for hot or cold packs and non-steroidal anti-inflammatory medications, $50 to $350 per physical therapy session and anywhere from $20,000 to $150,000 for surgery, depending on the kind of surgery and the severity of the condition. The physical therapy itself can run into thousands of dollars.

Looking at the kinds of surgery, a discectomy or microdiscectomy can run anywhere from $20,000 to $50,000 while a spinal fusion can cost as much as $150,000. Therefore, the overall cost of treating degenerative disc disorder is extremely expensive in the long-term.

The SSA Evaluation and Medical Qualifications

The problem with a degenerative disc disorder claim is that only the person who is suffering the pain knows the severity of it. When a disability examiner is looking at a case filed because of degenerative disc disorder, he or she will closely at the evidence, such as physician treatment notes that clearly state the diagnosis and objective evidence of disc deterioration, such as CAT scans, MRI reports and x-rays.

A medical guide by the SSA, called the Blue Book, is used to determine whether an individual is considered disabled per their guidelines. If you meet the requirements set forth in the Blue Book, you are considered eligible for benefits, but just because you don’t meet the guidelines set forth in the book does not mean you cannot prove your eligibility otherwise.

Degenerative Disc Disease is listed under Section 1.04 (Disorders of the Spine). There is not a listing for just degenerative disc disorder because oftentimes, its symptoms are intermittent.

To qualify automatically for SSDI because of degenerative disc disease, you must have to have severe symptoms such as requiring assistance to walk, needing to adjust your position more than every two hours and suffer from nerve-specific problems. Sometimes degenerative disc disorder causes further back problems that the SSA does recognize in the Blue Book.

If your degenerative disc disorder has led to herniated disc, spinal stenosis, nerve root compression or arachnoiditis, your odds of automatic approval for SSDI are significantly increased because those conditions will be considered in conjunction with your degenerative disc problem.

Meeting Disability Criteria with an RFC

Even if you don’t meet the qualifications for SSDI by the Blue Book, you can still qualify with the residual functioning capacity (RFC) form. If your disc disorder has impacted your functional capacity, which is your ability to work and do normal tasks, you may be eligible for benefits using a “medical-vocational allowance.”

This involves evaluating your doctor’s notes on your limitations and restrictions, as well as your pain levels. If your doctor indicates you can’t lift more than 20 pounds and it can only be done on occasion that has to be indicated and that will impact the decision.

If your back pain is so severe you have to adjust your position every hour, that also has to be noted on the form and it will help with your claim. This aspect also considers your work experience, your work related skills, your age, your educational level and your ability to transition into another role or another position.

Degenerative disc disorder and its severity are proven by x-rays, CAT scans and MRIs. If there are still any questions about the severity of your condition and if it impacts your ability to work, the SSA can order a medical evaluation at their expense for informational purposes only. This will be able to confirm your condition and verify your symptoms.

Sometimes mental evaluations are also ordered to determine if the condition has impacted your mental wellness by causing depression or anxiety which also impact your ability to work. Neither of the evaluations are designed for medical treatment, but for information confirmation use by the Disability Determination Services division.

The medical evaluation may also include basic tests, such as lab work or x-rays. You can start the SSDI application process online by visiting ssa.gov. The process can be lengthy and may involve several denials and appeals. It can eventually be sent before an administrative law judge for a final ruling, but approval can occur at one of many different levels. Hiring a disability attorney to represent you during the appeal process may increase your chance of winning an appeal or even an initial claim can be increased significantly with proper legal representation.

Before applying, be sure to read our article on tips on applying for disability benefits with DDD.

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